Torticollis

Torticollis is a chronic condition in which the neck muscles contract involuntarily. This causes the head to turn and tilt to one side, and the chin to point to the opposite side. Sometimes one shoulder is lifted. The muscle contraction may be constant (fixed) or may come and go (intermittent). The abnormal posture caused by tilting the head may lead to neck pain. Torticollis may be present at birth (congenital) or develop later in life (acquired).

Causes

The causes of Torticollis are not well understood.
Causes may include:
  • Genetic defect
  • Infants position during pregnancy or delivery
  • Upper respiratory infection
  • Head or neck injury
  • Damage or malfunction of the nervous system
  • Inner ear or eye problems
  • Deformities of the bones or muscles in the neck
  • Tumors of the head or neck
  • Arthritis of the neck
  • Use of certain medications, including:
    • Phenothiazines
    • Butyrophenones

Risk Factors

A risk factor is something that increases your chance of getting a disease of condition.
  • Sex: Female
  • Age: Newborn and children under age 10
  • Age: Adults 30 to 60 years
  • Family member with torticollis or similar disorders

Symptoms

Symptoms may include:
  • Rotation and tilting of the head to the affected side
  • Enlargement of neck muscles, possibly present at birth
  • Stiffness of neck muscles
  • Painful spasms of neck and upper back muscles
  • Limited range of motion of the head and neck
  • Headache
Torticollis ranges from mild to severe. It usually progresses slowly for 1-5 years, and then plateaus. However Torticollis may persist for life and can result in limited movement and deformed posture.

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam.
Tests may include:
X-ray of the Neck – a test that uses radiation to take a picture of structures inside the body
CT Scan of the Neck – a type of x-ray that uses a computer to make pictures of structures inside the body
MRI Scan of the Neck – a test that uses magnetic waves to make pictures of structures inside the body

Treatment

The treatment for Torticollis depends on whether it is congenital or acquired. Treatment may include:
Congenital Torticollis
  • Positioning of the infant to avoid sleeping on one side
  • Positioning of toys to encourage turning of the head
  • Stretching exercises several times each day
  • In some situations, surgery to cut the muscle that causes torticollis
Acquired Torticollis
  • Identifying the cause
  • Physical therapy to help relax the muscle and reduce pain
  • In some situations, surgery to cut the nerve to the muscle that is in spasm
  • Drugs:
    • Injection of botulinum toxin, which may weaken or partially paralyze the muscle. This may help improve neck posture. The drug's effect wears off after several months and treatment must be repeated.
    • Anticholinergic drugs, such as trihexyphenidyl, benztropine, and diphenhydramine
    • Muscle relaxants
    • Antidepressants
    • Injection of alcohol or phenol to deaden the nerve that causes the muscle contraction

Prevention

There are no guidelines for preventing Torticollis. Early treatment may help keep the symptoms from getting worse.